雅各布·巴克（Jacob Barker）
圣路易斯邮政
（MCT）
7月8日。路易斯 - 去年9月，一辆救护车到达救护车才到达医院花了38分钟。
与一辆小型货车相撞后，他在阿森纳街和伊万霍大街的交叉路口附近的汽车踏板车上被抛弃。几分钟后，一名救火车就在现场，可以提供一些急诊护理但无法运送他的人员。
By the time an EMS ambulance got LaRue to the hospital nearly an hour later, he was in critical condition. Later that evening, he died.
该事件是该市紧急医疗服务局如何努力满足需求的一个明显的例子。尽管劳动力短缺在各地挑战雇主，但EMS的人员配备问题甚至在大流行之前就存在。
Now, they’re worse.
In April, more than half of the city’s 55 paramedic positions were vacant, according to budget documents. Between staffing issues and wear and tear on the constantly running vehicles, only 10 of the city’s 12 ambulances are running “on a good day,” said one employee.
全国各地的EMS系统正在努力保持人员配备。但是，圣路易斯消防局的一个部门圣路易斯EMS的问题并不是什么新鲜事物。八年前，他们被召唤出来，当时EMS更接近全部力量。
最近通过后发现的一份鲜为人知的报告，甚至在当时概述了EMS的关键问题。
“The current system is not meeting the community’s demand for service and is performing with exceptionally long response times and frequent inability to respond,” concludes the 2014 report, commissioned by the city and authored by the Center for Public Safety Management, a consultancy formed by the nonprofit International City/County Management Association, known as ICMA.
That was hardly a new conclusion to Charlene Deeken, who worked closely with the fire department during her more than 20 years at the St. Louis Public Safety Department, where she retired as deputy director last year.
“Quite frankly, we have run them ragged for a lot of years,” Deeken said of EMS. “Now it’s compounded by the fact that there’s so many vacancies.”
公共安全主任丹·伊索姆（Dan Isom）将问题转交给圣路易斯消防局长丹尼斯·詹克森（Dennis Jenkerson）。
詹克森（Jenkerson）在进行ICMA报告时担任首席，他得出了一些结论。但是，就资源不足而言，他说他同意“ 100％”。
Every year that he’s served as chief, he said, he has asked for one of the report’s recommendations: a minimum of six additional ambulances to bolster EMS’s fleet of 12.
“I need more units,” Jenkerson said of EMS. “And manpower. But we haven’t been able to convince anybody to increase our manpower.”
詹克森（Jenkerson）表示，为了应对人员短缺，该部门在最近几周与两名私人救护车运营商达成了一项协议，在城市范围内为六架救护车站了一个救护车。
“I’ve got to take a little bit of the workload off of these people who’ve been going nonstop for a minimum of two years with COVID,” Jenkerson said. “When you ride a medic unit and you work a 12-hour shift and you’re handling 12, 15 sometimes 20 calls in that 12-hour shift? Way too much.”
A new class of about 12 paramedics is being added to the ranks now, Jenkerson said, lowering paramedic vacancies to about 20. And he’s looking at reshuffling firefighters to make sure there are at least two firetrucks staffed with a firefighter who has a paramedic license. They can provide on-scene treatment until an ambulance can transport a patient to the hospital.
Meanwhile, the department has been assigning firefighters, many of whom have EMT or paramedic licenses, to EMS shifts, or offering overtime to fill holes in EMS staffing.
The secretary-treasurer of the union that represents both city firefighters and EMS workers, fire Capt. Dan Clark, called the use of firefighters to fill EMS staffing holes a “Band-Aid.”
克拉克说：“归根结底，要保持EMS的前进，这必须是一些不错的加薪。”“多年来，我们一直在宣讲更多的人力和更多的救护车。这不是一个新问题。”
“失误很大”
根据ICMA报告，救护人员在大流行之前就已经过度劳累了，据报道，该市花费了200,000美元以上的委托。但是该报告完成后几乎没有宣传。在报告完成之前，2012年《劳工论坛报》的一篇文章很容易找到，该文章批评该公司被雇用为反工会。
一些缺乏宣传的时间是时机。它于2014年9月完成，正当该地区在弗格森（Ferguson）致命的迈克尔·布朗（Michael Brown）枪击事件发生后，该地区陷入了动乱。
但是财政和政治现实也陷入了当时的弗朗西斯·斯莱（Francis Slay）的管理。该报告中的建议将是昂贵的，有些人可能会引起圣路易斯消防局和有影响力的消防员工会的反对。
从广义上讲，该报告描绘了一个消防部门的图片，该消防员的消防员比类似的城市多，而在耐火的建筑和材料时代则遭受的火灾更少。同时，EMS局缺乏消防部门领导层的救护车，人员和关注，无法处理已成为呼叫的主要驱动力：医疗紧急情况。
Thomas Wieczorek, a principal at the Center for Public Safety Management who co-authored the St. Louis report, said tension between firefighting and EMS divisions isn’t unique to St. Louis.
“The two functions normally have conflict in the department, or we see it, and EMS is usually consuming more and more of the time of fire departments,” he said. “Most fire departments concentrate most of their resources on what’s in their name, the ‘fire.’ And the EMS is consuming most of their available time.”
In addition to adding six ambulances to the city’s 12-ambulance fleet, the report recommended cutting the city’s 30 fire stations by nearly half, to 17, with new stations built in strategic locations. That, the report said, would allow for a gradual reduction in the number of firefighting personnel from the 448 firefighters and 114 fire captains authorized in this year’s budget — more than four times the amount of EMS positions — to 360 total. Firefighting apparatus could also be cut from 36 to 24.
该报告说，电台和消防人员的数量“超过”，“行业建议和比188金博网网址多少较类似大小的社区”。
Jenkerson, though, said the city’s fire staffing is necessary to maintain four-minute response times, a standard that insurance companies can use to set premiums.
The demands on the EMS bureau, the ICMA authors found, were far heavier than on the fire prevention side of the department. The report analyzed calls for service in the fire department a decade ago and found nearly 74% of calls from July 2012 through June 2013 were EMS-related. Fire calls accounted for about 20%, or about 16,200 total, when canceled calls were excluded. Just 5% of total department calls were related to actual fires, and a quarter of all fire calls were false alarms.
前公共安全主任Deeken强调说：“等式的火力方面的专业精神是一流的。”但是实际的大火几十年来一直暴跌。
她说：“真正的大火，没有那么多。”“如果您是城市的消防员，那么您就不必像这座城市的护理人员那样努力工作，因此营业额很大。营业额并不是大火。”
Deeken说，EMS“总是在滚动”。“鉴于，有一整天没有接到电话的发动机房屋。或者，如果他们接到电话，那就是医疗。”
Jenkerson disputed that some engine houses never get calls. And he said some fire risks have increased. The new, mostly wood, four or five-story apartment buildings popular now “look like giant matchstick boxes. It’s all they are.”
他说：“轻量级的结构正在阻碍消防员扑灭大火的能力。”“而且，如果您不迅速到达，您就不会把它淘汰。”
无论如何，ICMA的建议都需要建造新的消防局来以战略性的方式覆盖城市，而不是上个世纪为有更多人和占领建筑物的城市建造的配置，并构建用于处理重新装备设备。詹克森（Jenkerson）不反对，整合一些车站并建造了新的车站来代替那些仍在该部门工作的时代建造的车站。他说，这可以逐步完成。
但是这个城市没有的资源。The Slay administration had commissioned the report in an era when the city faced constant budget shortfalls, so it was always looking for efficiencies across government. But implementing the recommendations would have been “extremely controversial and extremely expensive,” said Slay, who had spent considerable political capital just two years before pushing through reforms to an increasingly expensive firefighter pension program.
公民不喜欢关闭靠近房屋的消防局的想法。消防员很受欢迎。他们的工会很强大。
Slay在最近的一次采访中谈到该报告时说：“我们从未见过对此做任何事情的途径。”
‘Should have gotten that raise’
Some of the report’s findings sound similar to issues still going on today.
它重复呼吁巩固该市脱节的911派遣服务，警察调度员在此召集所有电话，然后必须将其转电到开火或EMS调度员。市长Tishaura O. Jones的政府最近创建了一个新的911个调度员职位，但其合并911派遣服务的计划花费的时间超过了预期。
人员配备问题也被注意到。ICMA报告观察到了十年前大部分研究的两位数中的护理人员和EMT空缺，达到19年。
“It is recommended that the department focus on recruitment and retention strategies for its employee pool and as well streamline the hiring process so that a more efficient replacement schedule is in place,” the report said.
The problem has grown: Out of 119 total paramedic, paramedic crew chief and EMT positions, 38 were vacant this spring, according to St. Louis budget documents. Only 25 of 55 paramedic positions were filled.
Wieczorek说：“我们的EMS系统正在挣扎。”“他们都在争夺开放的身体，可用的身体，并找到应对压力的合格申请人。您正在处理，尤其是最近两年，死亡和垂死。”
But one fire department employee said department leaders, most of whom come from the fire side, haven’t pushed hard enough to tackle the turnover and staffing issues identified in the ICMA report. The person, who asked to remain anonymous to speak outside of approved channels, recounted a joke among some in the department: “Don’t let progress get in the way of tradition.”
该人说：“十年前在这里的同一位人仍在这里。”
当被问及自报告以来是否进行了更改时，詹克森起初说“无”，但纠正了自己。他重申，多年来，他一直在推动更多的救护车和人员配备，并指出他经过EMT学校，并且是该系的EMT教练。他说，这项工作的压力有时“在员工中沸腾了。”
詹克森（Jenkerson）将EMS排除在2017年选民通过的提案P上的薪酬中的大部分不满意，这给了消防员和警察。
“I was furious,” Jenkerson said. “They’re part of the Fire Department, they should have gotten that raise. So that didn’t sit well on the EMS side. And you know what, I don’t blame them.”
他说，经验城市EMS工人在艰难的城市环境中获得了工作，使其成为其他部门或医院的“热门商品”，这可以支付更多。通常，他们被引诱。
詹克森说：“我非常同情该部门的EMS方面。”“但是，直到我能保证他们更多的钱之前，我将很难坚持下去。”
‘Let’s do something else’
消防部门于1997年从卫生部门接受了该市的EMS服务。但是在那之后的16年之后，ICMA报告发现“几乎没有任何无缝整合的证据。”作者补充说，EMS局“从未被消防部门完全接受”。
“It was apparent to the ICMA study team that there is an overarching separation and tension between the St. Louis Fire Department proper and the Bureau of EMS,” the report said.
该市EMS服务的一位护理人员三年前在大流行之前写了一封信，写了一封有关离开服务的护理人员的人数。他引用了低薪，而没有被包括在警察和火灾中的提高薪水中，以及“管理层缺乏尊重和待遇不佳”。
“It is not the trauma of the job causing us to leave,” he wrote. “It is being constantly overworked and underpaid, treated like second-class citizens and having trucks that are constantly breaking down.”
Clark, the union official, said some of that division was improving, but the exclusion of EMS from Proposition P “relit that fire.”
Jenkerson and Clark said a new job classification for a “paramedic firefighter” could begin breaking down the wall between fire and EMS. The classification could offer higher pay and a chance for promotion for fire privates waiting to make captain. Some shifts they’d ride an ambulance. Other shifts they would ride a firetruck.
“I think they should be one integrated service,” Jenkerson said. “It needs to be done.”
前公共安全官员Deeken长期以来一直倡导混合动力部门。许多消防员已经被认证为护理人员或EMT。她说，他们经常出现在百万美元的救火车中，但无法将人们运送到医院。将一些消防员转移到救护车上，并购买更多的救护车，以改善城市的响应时间。她说，其他部门这样做。没有人必须失业。
“You might have to move some fire stations, you might have to combine some and do double houses in better-located places with some capital money, which as far as I’m concerned, the city is swimming in right now,” Deeken said. “Maybe push has come to shove. That’d be a good thing.”
她说：“很明显，这是不起作用的。让我们做其他事情。”
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（c）2022圣路易斯邮政-Dispatch
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